Beyond Flexner Alliance Response to WSJ Commentary on Social Justice Training in Medical Education

The BFA challenges an opinion in the Wall Street Journal that physicians cannot and should not strive to address the social injustice.

Medical Schools Do Need an Overhaul.

Doctors need to be trained in public health, health equity, and social justice.
COVID-19 is laying bare society’s underlying structural inequities that increase the risk of exposure, infection, and death for minority and disadvantaged communities across the US. The pandemic is also disproportionately affecting healthcare workers, who continue to work despite insufficient personal protective equipment and further, face disciplinary actions for speaking out.

Despite these realities, Dr. Stanley Goldfarb in his April 13 commentary suggests “doctors should be trained in pandemics, not injustice,” and that “the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism.” Clinical care is estimated to account for only 10-20% of what ultimately impacts health outcomes. Social determinants of health – health behaviors, social and economic factors, and the physical environment – account for the other 80-90% (National Academy of Medicine). The attitude that physicians should focus solely on clinical care aims to disempower the profession and frankly, is dangerous.

In light of the current pandemic, what would the nation look like now if physicians had been trained and empowered to address the organizational and social deficits that underlie the health disparities and health worker mistreatment occurring with COVID-19?
Training physicians in public health is, in truth, a good start. However, identifying social justice training in medical schools as the primary reason for poor public health communications is a fallacy. Public health training requires understanding of social epidemiology, health equity, and social determinants of health. The Public Health Foundation includes policy development and leadership and systems thinking skills as two of eight core competencies for public health professionals. It’s not enough to collect, analyze, and interpret data, the information must be translated into policies and actions that protect and advance the public’s health. The Department of Health and Human Services’ Public Health 3.0 Initiative explicitly called for public health to evolve to include social determinants of health through cross sector and community collaborations.

While there are some valid concerns in the piece, the main thesis is a form of policy misdiagnosis. Unfortunately he is guilty of confirmation bias – pulling and conflating a bunch of observations together to prove a point he’s dying to make. As such, it would be inadvisable for any educator or policy maker to follow his misguided recommendations.
Finally, it is important to recognize that health care and public health are team sports, made up of many health care and public health professionals, community members, patients, and others. It is time for an overhaul of health professions education – to fully integrate public health, health equity, social justice, advocacy, and leadership – to create a league of health professionals who will meet society’s priority needs and work to eliminate health disparities.
The April 13 commentary calls out the Beyond Flexner Alliance for advocating for medical schools to increase teaching on social and organizational topics. The mission of the Beyond Flexner Alliance is to promote social mission – the contribution of health profession schools in their mission, programs, and the performance of their graduates, faculty, and leadership in advancing health equity and addressing the health disparities of the society in which they exist.

Training in health equity and social justice is social mission, and the Beyond Flexner Alliance is proud to support it.